title: Long-term clinical outcome after fractional flow reserve- versus angio-guided percutaneous coronary intervention in patients with intermediate stenosis of coronary artery bypass grafts.
abstract: BACKGROUND
  Fractional flow reserve (FFR)-guided percutaneous revascularization (percutaneous coronary intervention [PCI]) of intermediate stenosis in native coronary artery is safe and associated with better clinical outcomes as compared with an angiography-guided PCI. It is unknown whether this applies to coronary artery bypass grafts (CABGs).
  
  
  METHODS
  We included 223 patients with CABG and with stable or unstable angina and an intermediate stenosis involving an arterial or a venous graft. Patients were divided into 2 groups: FFR guided (n = 65, PCI performed in case of FFR ≤0.80) and angio guided (n = 158, PCI performed based on angiographic evaluation). Primary end point was major adverse cardiac and cerebrovascular event, defined as death, myocardial infarction, target vessel failure, and cerebrovascular accident (CVA).
  
  
  RESULTS
  The 2 groups were similar in terms of demographic and clinical characteristics. Percutaneous coronary intervention was performed in 23 patients (35%) of the FFR-guided group and 90 patients (57%) of the angio-guided group (P < .01). In the FFR-guided group, PCI was more often performed in arterial grafts as compared with the angio-guided group (16 [70%] vs 12 [13%], respectively; P < .01). Follow-up was obtained in 96% of patients at a median of 3.8 years (1.6-4.0 years). At multivariate analysis, major adverse cardiac and cerebrovascular event rate was significantly lower in the FFR-guided group as compared with the angio-guided group (18 [28%] vs 77 [51%], hazard ratio 0.33 [0.11-0.96], P = .043]. Procedure costs were overall reduced in the FFR-guided group (€2240 ± €652 vs €2416 ± €522, P = .03).
  
  
  CONCLUSIONS
  An FFR-guided PCI of intermediate stenosis in bypass grafts is safe and results in better clinical outcomes as compared with an angio-guided PCI. This clinical benefit is achieved with a significant overall reduction in procedural costs.
authors.affiliation: Cardiovascular Center Aalst OLV Clinic, Aalst, Belgium.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Serafino
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.forename: Fabio
authors.initials: F
authors.lastname: Mangiacapra
authors.forename: Jozef
authors.initials: J
authors.lastname: Bartunek
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Marc
authors.initials: M
authors.lastname: Vanderheyden
authors.forename: Gabriella
authors.initials: G
authors.lastname: Scognamiglio
authors.forename: Guy R
authors.initials: GR
authors.lastname: Heyndrickx
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.forename: Emanuele
authors.initials: E
authors.lastname: Barbato
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome